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Post-traumatic growth among high-risk youth: predictors, impact of stressful life events, and relationship with changes in substance use behaviors

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POST-TRAUMATIC GROWTH AMONG HIGH-RISK YOUTH:
PREDICTORS, IMPACT OF STRESSFUL LIFE EVENTS, AND RELATIONSHIP
WITH CHANGES IN SUBSTANCE USE BEHAVIORS
by
Thalida Em Arpawong
A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PREVENTIVE MEDICINE)
August 2013
Copyright 2013 Thalida Em Arpawong

Background: The experience of a highly stressful life event (SLE) may elicit positive psychosocial change in some individuals, referred to as Post-traumatic Growth (PTG). This dissertation represents novel research in which two studies were designed to answer the following questions: (1) what predicts PTG, including personal and environmental characteristics as well as the number and severity of stressfulness of SLEs experienced?; and (2) how do SLEs and PTG influence changes in the frequency of substance use behaviors over time among vulnerable, ethnically diverse, older youth? In addition, theoretical postulates were tested to examine whether mean scores of PTG in this sample represent an illusory perception of growth as a transient palliative strategy to regain a sense of self-esteem post-SLE or if PTG scores represent an attempt to achieve congruence through growth in both cognitive and behavioral functioning. ❧ Methods: Students were recruited from alternative high schools (n=564; mean age=16.8), where they participated in the Project Toward No Drug Abuse intervention. Surveys were administered in-person, by phone or mail-back. Data regarding socio-demographic, personal and environmental characteristics were collected at baseline and 1-year follow-up. Data regarding SLEs and PTG were collected at 2-year follow-up. Data on substance use behaviors were collected at both baseline and 2-year follow-up. For both studies, multi-level regression models were constructed, controlled for sociodemographic variables, peer and baseline substance use, attrition, and treatment group where relevant. For the exploratory moderation in Study 1, interaction terms were created between ethnicity and each of the potential predictors to evaluate their relationship with PTG. ❧ Results: Nearly half of the participants were female; 65% were Hispanic, and on average, all reported experiencing 3 SLEs in the past two years. Findings from Study 1 were that the majority of participants reported developing PTG as a result of their most life-altering SLE. Predictors of PTG included fewer SLEs, less general stress, greater identification with the developmental stage of Emerging Adulthood, and an interaction between Hispanic ethnicity and future time perspective. Findings from Study 2 were that a greater number of SLEs predicted greater use of cigarettes, alcohol, marijuana, hard drugs and substance use. In contrast, greater PTG significantly predicted less use of alcohol, getting drunk on alcohol, binge drinking, marijuana use, and substance abuse. ❧ Conclusions: Taken together, findings from these studies indicate that high-risk, older youth report SLEs that reflect their unique life stage and set of circumstances. Constructs that assessed stage of life were more salient in predicting PTG than were constructs reflecting mood states (i.e., depression, positive affect), although future time perspective predicted higher PTG among Hispanics only. Regarding theoretical postulates, the finding that higher PTG predicted less substance use suggests that higher PTG scores were not representative of transient or merely illusory exaggerations of post-SLE adjustment rather they were indicative of growth on both the cognitive and behavioral levels among these youth. Furthermore, although greater SLEs predicted lower PTG, findings from these studies support the notion that positive psychosocial adjustment to a life-altering experience may counteract the negative impact of stress from SLEs on substance use behaviors among high-risk youth.

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i
POST-TRAUMATIC GROWTH AMONG HIGH-RISK YOUTH:
PREDICTORS, IMPACT OF STRESSFUL LIFE EVENTS, AND RELATIONSHIP
WITH CHANGES IN SUBSTANCE USE BEHAVIORS
by
Thalida Em Arpawong
A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PREVENTIVE MEDICINE)
August 2013
Copyright 2013 Thalida Em Arpawong